Poneke Kyokushin Registration Form
Please complete this form once for each person who may be interested in becoming a member.

This completed form will be emailed to the address provided. Please print the completed form and give it to the instructor when you arrive at your first session.

Someone will be in touch with you to discuss membership. You will not be registered as a member of Poneke Dojo until you confirm your interest by becoming financial / paying on invoice.

Personal Information
Student's First Name
Your answer
Surname
Your answer
Date of Birth
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Gender
Contact Details
Contact Name (Parent or Guardian for kids)
Your answer
Mobile Phone Number
Your answer
Other Phone Number
Your answer
Email Address
Your answer
Street Address
Your answer
Suburb
Your answer
City
Your answer
Postcode
Your answer
Any Other Contact Information
Your answer
Training Preferences
Select up to two options
Required
Select preference
Based on student age, size, maturity and personal goals
To help the Club
How did you hear about Poneke Dojo?
Acknowledgements
Kyokushin Karate is a traditional Japanese martial art that requires intense physical exertion. Full contact fighting is a component of Kyokushin. While every effort is made to protect the comfort and safety of all students there is an inherent risk of pain and injury.
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